Addressing Adolescent Relationship Abuse in the Context of Reproductive Health Care

Adolescent relationship abuse (ARA) is a significant public health issue that includes physical, sexual, psychological and cyber abuse, reproductive coercion, and/or sexual exploitation within an intimate relationship in which one or both partners is a minor. ARA is associated with numerous negative outcomes that include all domains of health. Many negative outcomes of ARA are related to reproductive and sexual health (RSH); thus, reproductive health care providers must be equipped to recognize and address ARA. This article will review the epidemiology and outcomes of ARA, followed by a discussion of means to robustly address ARA in health care settings. We recommend a strengths-based approach that promotes healthy adolescent relationships, connects adolescents experiencing ARA to harm reduction resources, and equips adolescents to serve as a resource for their peers.

Quality Initiative to Increase Delivery of Adolescent Hospital-Based Reproductive Health Care

OBJECTIVES: Hospitals are an important nontraditional setting in which to address adolescent reproductive health. However, opportunities for intervention are frequently missed, especially for boys and patients hospitalized for noningestion complaints. Our global aim was to increase delivery of reproductive health care to adolescents hospitalized through our children’s hospital Pediatric Hospital Medicine service. METHODS: We performed 2 quality improvement intervention cycles: (1) provider education and monthly reminder e-mails and (2) an automated electronic health record (EHR) adolescent history and physical note template with social history prompts while discontinuing reminder e-mails. The primary outcome measure was sexual history documentation (SHD). Secondary measures were sexually transmitted infection (STI) testing and contraception provision. Statistical process control charts were used to analyze effectiveness of interventions. RESULTS: From July 2018 through June 2019, 528 Primary Hospital Medicine encounters were included in this study and compared with published baseline data on 150 encounters. Control charts revealed a special cause increase in SHD from 60% to 82% overall, along with 37% to 73% for boys and 57% to 80% for noningestion hospitalizations. Increased SHD correlated with cycle 1 and was maintained through cycle 2. Percent STI testing significantly increased but did not shift or trend toward special cause variation. Contraception provision, length of stay, and patient relations consultations were not affected. CONCLUSIONS: The interventions were successful in increasing SHD, including among boys and noningestion hospitalizations. The EHR enhancement maintained these increases after reminder emails were discontinued. Future interventions should specifically address STI testing and provision of contraception.

The Continuing Impacts of the COVID-19 Pandemic in the United States: Findings from the 2021 Guttmacher Survey of Reproductive Health Experiences

In this report, we analyze the 2021 data, focusing on how respondents feel the COVID-19 pandemic has influenced their sexual and reproductive health in two core areas: fertility preferences and access to care, including use of telehealth. We note disparities according to individuals’ race and ethnicity, sexual orientation, gender identity, income level and economic well-being. To assess the ongoing scope and magnitude of the impacts of the pandemic, we also examine findings on comparable measures from the 2020 and 2021 GSRHE studies. These data provide four key findings: The pandemic has continued to shift fertility preferences and impede access to sexual and reproductive health care, including contraceptive services. The impacts reported in the summer of 2021 are smaller than those reported earlier in the pandemic but remain pervasive. The pandemic continues to have disproportionate effects on the sexual and reproductive health of those already experiencing systemic social and health inequities. Telehealth services are bridging gaps in sexual and reproductive health care resulting from pandemic-related upheaval, particularly for those who already experience barriers to accessing health care.

Emotional Health Work of Women With Female Genital Cutting Prior to Reproductive Health Care Encounters

We used institutional ethnography to explore the social relations that shaped the reproductive health care experiences of women with female genital cutting. Interviews with eight women revealed that they engaged in discourse that opposed the practices of cutting female genitals as a human-rights violation. This discourse worked to protect those affected by the practices, but also stigmatized female genital cutting, making participants anticipate experiencing stigmatization during health care. Women’s engagement in this discourse shaped their emotional health work to prepare for such encounters. This work included navigating feelings of worry, shame, and courage to understand what to expect during their own appointment; learning from family/friends’ experiences; and seeking a clinic with the reputation of best care for women with female genital cutting. It is important to strive for more inclusive health care in which women do not have to engage in emotional health work to prepare for their clinical encounters.

“Making a Way Out of No Way:” Understanding the Sexual and Reproductive Health Care Experiences of Transmasculine Young Adults of Color in the United States

Research focusing on the specific and unique sexual and reproductive health care experiences of transmasculine young adults of color are extremely scarce. We conducted five focus group discussions with 19 Black, Latinx, Asian, Native, and other transmasculine individuals of color aged 18–25 years in the greater Boston area. Using thematic analysis, we found that transmasculine young adults of color experienced cissexism, heterosexism, and racism in accessing and utilizing sexual and reproductive health services. These multiple forms of discrimination undermined participants’ receipt of high-quality sexual and reproductive health information and care from competent health care providers who shared their lived experiences. Participants relied on support from their lesbian, gay, bisexual, transgender, and queer peers to obtain needed sexual and reproductive health resources and minimize harm during clinical encounters. Multilevel interventions are needed to promote access to person-centered and structurally competent sexual and reproductive health care among transmasculine young adults of color.

Access to Reproductive Health Care Services among African Women Living in Beijing: Understanding the Challenges

A growing body of research has explored the health care experiences of African migrants in China. However, within this body of research, there is a lacuna on access to reproductive health care among African women within this population. The study adopted semi-structured interviews in exploring the challenges to reproductive health care services among African women in Beijing. Results indicate that African women face multiple barriers to accessing reproductive health care. In particular, the absence of reproductive health education and awareness, discriminatory immigration policy, discontentment with health care services, and language barrier were the key challenging factors identified. The study recommends the implementation of secure and equitable policies that cater for the need of minority groups in a multicultural context.